Parallel ridge dermoscopic pattern in plantar atypical Spitz nevus

Clinicopathological classification, diagnosis and management of spitzoid melanocytic lesion presents one of the most intriguing issues in dermatopathology (1,2). No single clinicopathological feature can offer reliable differentiation of Spitz nevus and melanoma. Although not all the experts agree with the concept of Spitzoid neoplasms as a morpho-biological spectrum, there is a four-tiered classification system proposed by Da Forno et al. and encompassing: 1) Spitz nevus; 2) atypical Spitz nevus; 3) (atypical) Spitz tumor; 4) Spitzoid melanoma (1,3). It is commonly said that Spitz nevus can show all the "local" dermoscopic features of melanoma, but in a more or less tidy fashion (4). The occurrence of melanoma-like dermoscopic pattern in Spitz nevus is also possible (4). The relationship between dermoscopic and histopathologic atypia is not absolute, in as much as dermoscopically atypical lesions are not necessarily histopathologically atypical as well.

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